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Mr Roberts asked: “Does there ever come a point in time when you say, look, this is too long ago, the information is too vague, there are too many gaps in it to understand physically what has happened, you can’t venture an opinion on whether this was accidental or not?”

Dr Steele answered: “I’m sure there would come a time if you had no witness statements at the time, had no photographs.

“In this case it was a while ago but there are a lot of witness statements and a lot of medical information.”

Mr Roberts also asked whether it was possible that the child may have sustained the injuries by jumping on the bed, then falling off.

Dr Steele said if a jumping child was going to break something, it would be a limb as opposed to hitting their head, and the awake child would have protective instincts and might be able to break his fall.

She said: “We just know that most children when they’re jumping and rolling off beds from this height don’t receive significant head injuries.”

Dr Steele was further questioned about non-fatal injuries suffered by Paul, including bruises.

She said the bruising around the jaw was “extremely unusual”.

“I’ve very rarely seen that level of bruising around both jaw lines.

“It’s difficult to come up with an accidental explanation. I’ve not seen bruising like that from an accident.”

An inquest into Paul Booth’s death recorded an open verdict.

The jury has heard evidence from Peter Booth, who described seeing Dearlove smash his brother Paul’s head into a fireplace.

Dearlove, now of Great Yarmouth, denies murder, manslaughter and three counts of child cruelty.